Correlation between the cervical sagittal alignment and spine - pelvic sagittal alignment in asymptomatic adults.

Background: Although there are studies that adequately document the linear correlation between pelvic incidence (PI), sacral slope, lumbar lordosis, and thoracic kyphosis, few have analyzed the pelvic-spine correlation including the cervical spine. Methods: This is a cross-sectional study, wherein the cervical spine was evaluated using radiography and computed tomography (CT) scans, the lumbosacral spine and the pelvis was evaluated using radiography, in adult patients without spinal pathology. Using the Surgimap tool, cervical and spinopelvic parameters were calculated by several investigators. To evaluate the correlation between cervical and spinopelvic parameters, Spearman's coefficient was calculated. To evaluate the concordance correlation of the measured parameters of cervical sagittal alignment on tomography and conventional radiography, Lin's coefficient was calculated and Bland-Altman plots were performed. Results: A total of 51 healthy adults were included in a follow-up from January 2019 to December 2020. Cervical sagittal alignment and sagittal spinopelvic alignment were assessed using radiography, and a correlation was observed between T1 slope (T1S) and lumbar mismatch (coefficient of 0.28, P = 0.047). Then, cervical sagittal alignment was evaluated using CT and sagittal spinopelvic alignment using radiography, and no correlation was observed between PI and thoracic inlet angle or cervical mismatch with lumbar mismatch. Conclusion: In asymptomatic patients, in whom cervical sagittal alignment and spinal-pelvic alignment were evaluated, only a positive correlation was found between lumbar mismatch and T1S, which lacks clinical significance. No concordance was identified between lumbar mismatch and cervical mismatch. Therefore, it is inferred that there is an independence between the sagittal spine-pelvic alignment with respect to the sagittal cervical alignment.

Relación del índice nutricional pronóstico con complicaciones y mortalidad en los pacientes con cáncer gástrico sometidos a gastrectomía en un hospital de tercer nivel de Bogotá, Colombia / Relationship of the prognostic nutritional index with complications and mortality in patients with gastric cancer who underwent gastrectomy in a tertiary hospital in Bogotá, Colombia

Introducción. El cáncer gástrico es el quinto cáncer diagnosticado con mayor frecuencia y la tercera causa de muerte por cáncer en el mundo. En el tratamiento quirúrgico, la evidencia actual apoya las medidas preoperatorias e índices pronósticos para mejorar la supervivencia. El índice nutricional pronóstico, que une los valores de los linfocitos circulantes en sangre periférica con los de la albúmina sérica, ha presentado características de ser un marcador nutricional e inmunológico con valor predictivo sobre complicaciones y mortalidad. El objetivo de este estudio fue determinar la relación entre el índice nutricional pronóstico con las complicaciones y mortalidad en pacientes con cáncer gástrico sometidos a gastrectomía. Métodos. Se llevó a cabo un estudio observacional descriptivo, de corte transversal, con componente analítico, mediante la revisión retrospectiva de las historias clínicas. Resultados. Se analizaron 113 pacientes sometidos a gastrectomía total o subtotal. Se encontró asociación entre el índice nutricional pronóstico y la mortalidad; todos los pacientes que murieron tenían un índice menor o igual a 46. También se encontró asociación inversa entre el valor del índice y la presentación de complicaciones posoperatorias, como sepsis, peritonitis, fuga de la anastomosis y sangrado. Discusión. Similar a nuestro análisis, varios estudios plantean que un índice nutricional pronóstico bajo podría tener un valor predictivo sobre la frecuencia de complicaciones y supervivencia global en pacientes con cáncer gástrico llevados a cirugía. Conclusión. El índice nutricional pronóstico se asocia con la mortalidad y complicaciones posoperatorias en pacientes sometidos a gastrectomía por cáncer gástrico.

Introduction. Gastric cancer is the fifth most frequently diagnosed cancer and the third cause of cancer death in the world. In surgical treatment, current evidence supports preoperative measures and prognostic index to improve survival. The prognostic nutritional index, which unites the values of circulating lymphocytes in peripheral blood with those of serum albumin, has presented characteristics of being a nutritional and immunological marker with predictive value on complications and mortality. The objective of this study was to determine the relationship between the prognostic nutritional index with complications and mortality in patients with gastric cancer undergoing gastrectomy.Methods. A descriptive, cross-sectional, observational study with an analytical component was carried out by a retrospective review of medical records. Results. A total of 113 patients who underwent total or subtotal gastrectomy were analyzed. An association was found between mortality and the prognostic nutritional index and mortality; all patients who died had an index ≤ 46. An inverse association was also found between the value of the index and the presentation of postoperative complications, such as sepsis, peritonitis, anastomotic leak, and bleeding.Discussion. Similar to our analysis, several studies suggest that a low prognostic nutritional index could have a predictive value on the frequency of complications and overall survival in patients with gastric cancer undergoing surgery.Conclusion. The prognostic nutritional index is associated with mortality and postoperative complications in patients undergoing gastrectomy for gastric cancer.

Milk let-down in goats can be influenced by the type of stimuli applied or to which goats are exposed during suckling and hand milking.

The present experiments on goats were conducted with the aim of verifying (a) whether the identity of the goat kids can affect the characteristics of milk let-down during suckling (Study 1) and (b) whether the presence of the goat kids may improve the milk let-down during hand milking (Study 2). In Study 1, 16 lactating goats with twins and 12 with single kids were used. Dams with single goat kids ejected more milk when suckling their kids at Days 5 and 20 of lactation, than when suckling aliens. Dams with twins ejected more milk when suckling their own kids than aliens only at Day 5 of lactation. Taking into account all the dams, they ejected more milk with more fat, protein, and lactose during suckling their own litter than when suckling aliens. In Study 2, when dams (n = 13) were hand milked in the presence of their own litter or in its absence, they ejected more milk with more fat, protein, and lactose than when milked in the presence of alien kids. We conclude that milk let-down in goats can be influenced by the type of stimuli applied or to which they are exposed to during suckling and milking.

In dual-purpose subtropical goats, 1 h of extra-light given from 16 to 17 h after dawn (pulse of light) in winter stimulates milk yield.

This research communication addresses the hypothesis that in dual-purpose goats, exposure to 1 h of extra-light given from 16 to 17 h after dawn (pulse of light) in winter stimulates milk yield. One group of goats was maintained under natural short photoperiod (natural day; ND (n = 7)). Another group of lactating females was submitted to an artificial long-day photoperiod consisting of 16 h light and 8 h darkness (long days; LD (n = 7)). A third group of females received one single hour of extra-light 16 h after the fixed dawn (pulse of light; PL (n = 6)). Goats from LD and PL yielded 30% more milk than goats from ND. Mean percentages of fat, protein and lactose contents in milk did not differ between the 3 groups at any stage of lactation, but these components in grams/day were higher in goats from PL than in the others two groups within the first 45 d of lactation. In conclusion, dual-purpose lactating goats that started their lactation during natural short days, the daily exposition to a 1-h pulse of light is sufficient to stimulate milk yield compared to females maintained under natural short photoperiod.

A Randomized Placebo-Controlled N-of-1 Trial: The Effect of Proton Pump Inhibitor in the Management of Gastroesophageal Reflux Disease.

Background: Gastroesophageal reflux disease (GERD) is the most frequent chronic gastrointestinal disorder. It is defined as a condition developed when the reflux of gastric contents causes troublesome symptoms (heartburn and regurgitation). This requires adequate treatment since it can lead to long-term complications including esophagus adenocarcinoma. Proton pump inhibitors (PPI) are generally used to treat GERD due to their high-security profile and efficiency on most patients. However, recurrent reflux despite initial treatment is frequent. N-of-1 trial is a study that allows the identification of the best treatment for each patient. The objective of this study is to compare the efficacy of standard dose with double dosage of esomeprazole, to improve the GERD symptoms in a single patient. Methods: A single-patient trial, placebo-controlled, randomized, double-blind, was carried out from September 25th, 2012, to April 26th, 2013. It included one outpatient at the gastroenterology service in a fourth-level hospital, diagnosed with nonerosive reflux disease (NERD). Yet, his symptoms were heartburn and reflux, and his endoscopic results were normal esophageal mucosa, without hiatal hernia, though pathological pH values. A no-obese male without any tobacco or alcohol usage received esomeprazole 40 mg/day and 40 mg/bid for 24 weeks. A standardized gastroesophageal reflux disease questionnaire (GerdQ) was used weekly to evaluate symptom frequency and severity. The consumption of 90% of the capsules was considered as an adequate treatment adherence. D'agostino-Pearson and Wilcoxon test were used to determine normal or nonnormal distribution and compare both treatments, respectively, both with a significant statistical difference of p < 0.05. Results: The patient completed the study with 96% of adherence. The double dosage of esomeprazole did not improve the control of symptoms compared with the standard dosage. Mean symptomatic score was 9.5±0.5 and 10.2±0.6 for each treatment, respectively (p > 0.05). Conclusion: There was no significant improvement in the patient GERD symptoms increasing the dose of oral esomeprazole during the 6 months of study. N-of-1 trials in chronic pathologies including GERD are recommended due to their potential value as systematic methods that evaluate therapies without strong scientific evidence.

A high level of male sexual activity is necessary for the activation of the medial preoptic area and the arcuate nucleus during the 'male effect' in anestrous goats.

In small ungulates such as sheep or goats, the introduction of a male among a group of anovulatory females during the anestrus season leads to the reactivation of the gonadotrope axis and ovulation, a phenomenon known as the 'male effect'. In goats, our previous studies have demonstrated the importance of male sexual activity for an efficient reactivation of the gonadotrope axis assessed through ovulation and blood LH pulsatility. In the present experiment, we assessed whether the level of male sexual activity would also induce differential activation of two brain regions of key importance for the reactivation of GnRH activity, namely the medial preoptic area and the hypothalamic arcuate nucleus. In both structures, we observed a differential activation of Fos in females, depending on the level of buck sexual activity. Indeed, goats unexposed to males showed low levels of expression of Fos while those exposed to sexually inactive bucks showed an intermediate level of Fos expression. Finally, the highest level of Fos expression was found in females exposed to sexually active males. However, and contrary to our initial hypothesis, we were not able to find any specific activation of kisspeptin cells in the arcuate nucleus following the introduction of highly sexually active males. As a whole, these results demonstrate that the level of male sexual activity is a key factor to stimulate brain regions involved in the control of the gonadotrope axis in the context of the male effect in goats.

Violencia urbana, conflicto y crimen en Medellín: una revisión de las publicaciones académicas al respecto / Urban violence, conflict and crime in Medellin: a review of academic publications on this matter / Violência urbana, conflito e crime em Medellín: uma revisão das publicações académicos na matéria

El objetivo es hacer una revisión bibliográfica de los estudios sobre la violencia urbana, el conflicto y el crimen en la ciudad de Medellín. Método: se realizó una búsqueda y selección de las investigaciones que indagaran sobre dichos temas, tanto en libros como en artículos académicos y en informes. Se aborda de forma cualitativa y poniendo énfasis en la producción académica realizada entre el 2000 y el 2015. Se describe la tendencia de las investigaciones y sus interpretaciones acerca de la disminución del homicidio en la ciudad, así como algunos factores relevantes de dichos estudios, como: enfoque conceptual, enfoques metodológicos, factores explicativos de la violencia urbana, modalidades e indicadores, actores armados, dinámicas de la violencia urbana y los impactos de la violencia en la sociedad. Resultado: se expone una situación paradójica: mientras que el homicidio en la ciudad ha decrecido en los últimos 25 años, la producción académica presenta un crecimiento importante, tanto en su cantidad como en su calidad. Además, son escasos los trabajos que abordan a fondo el problema de las reglas informales y su papel en el aumento o en la disminución de la criminalidad y la violencia.

The objective consists of reviewing the bibliography of studies made about urban violence, conflict and crime in the city of Medellin. Method: A careful search and selection of researches having explored these areas was made both in books, journals, academic articles and reports. They were approached in a qualitative manner and with emphasis on academic production between years 2000 and 2015. The trend of researches and their interpretations dealing with the decline of homicide cases in the city are described, as well as some relevant factors emerging from these studies ike, for example, conceptual approach, methodological perspective, explanatory factors for urban violence, modalities and indicators, armed actors, urban violence dynamics, and the impacts of violence on society. Result: A paradoxical situation is exposed: while homicide has declined in the past 25 years, the academic production exhibits significant growth in both quantity and quality aspects. Besides, works addressing in depth the issue of informal rules and their role in either the increase or decrease of criminality and violence are rather scarce.

O objetivo é fazer uma revisão bibliográfica dos estudos sobre a violência urbana, o conflito e o crime na cidade de Medellín. Método: uma busca e seleção das pesquisas que indagam nestes assuntos foi feita, tanto nos livros quanto em artigos académicos e relatórios. Tem uma abordagem qualitativa e ênfase na produção académica feita entre 2000 e 2015. Descreve-se a tendência das pesquisas e de suas interpretações sobre a redução do homicídio na cidade, assim como alguns fatores relevantes destes estudos, como: enfoque conceptual, aproximações metodológicas, fatores explicativos da violência urbana, modalidades e indicadores, atores armados, dinâmicas da violência urbana e os impactos da violência na sociedade. Resultado: uma situação paradoxal é exposta: visto que o homicídio na cidade diminuiu nos últimos 25 anos, a produção académica apresenta um crescimento importante, tanto em sua quantidade quanto em sua qualidade. Além, os trabalhos que abordam em profundidade o problema das regras informais e de seu papel no aumento ou redução da criminalidade e da violência são escassos.

Male goat vocalizations stimulate the estrous behavior and LH secretion in anestrous goats that have been previously exposed to bucks.

We investigated whether live vocalizations emitted by bucks interacting with anestrous females stimulate secretion of LH, estrous behavior and ovulation in anestrous goats. In experiment 1, bucks rendered sexually active by exposure to long days followed by natural photoperiod were exposed in a light-proof-building to five anestrous females. Buck vocalizations were reproduced through a microphone-amplifier-loudspeaker system to an open pen where one group of goats (n=6) was exposed for 10 days to these live vocalizations. Another group of females (n=6) was isolated from males and vocalizations. The proportion of goats displaying estrous behavior was significantly higher in females exposed to buck vocalizations than in females isolated from males. The proportion of goats that ovulated did not differ between the 2 groups (exposed to males versus isolated). In experiment 2, female goats that either had previous contact with males (n=7), or no previous contact with males (n=7) were exposed to live buck vocalizations, reproduced as described in experiment 1, for 5 days. The number and amplitude of LH pulses did not differ between groups before exposition to buck vocalizations. Five days of exposure to male vocalizations significantly increased LH pulsatility only in females that had previous contact with males, while LH pulse amplitude was not modified. We concluded that live buck vocalizations can stimulate estrous behavior and LH secretion in goats if they have had previous contact with bucks.

Lack of sexual experience does not reduce the responses of LH, estrus or fertility in anestrous goats exposed to sexually active males.

We investigated whether LH secretion, estrous behavior and fertility would differ between sexually inexperienced and experienced anestrous goats exposed to the males. Male goats were rendered sexually active during the reproductive rest season by exposure to 2.5 months of artificial long days. Two groups of anovulatory sexually inexperienced and sexually experienced does were exposed to males during 15 days (n = 20 per group). LH pulsatility was determined every 15 min from 4h before to 8h after introducing males (Day 0). Estrous behavior was recorded twice daily. Pregnancy rates were determined on Day 50. Fertility was determined at parturition. Male sexual behavior was registered on days 1 and 2 during 1h. Before introducing the males, the number of LH pulses did not differ between groups. After introduction of the males, all females increased their LH pulsatility, but the number of pulses did not differ between sexually inexperienced and experienced goats. The proportion of females displaying estrous behavior with a high pregnancy rate and fertility did not differ between inexperienced and experienced goats. The sexual behavior of the males did not differ significantly between those interacting with sexually inexperienced or experienced goats. We conclude that goats can show substantial endocrine and reproductive responses to males, even in the absence of previous sexual experience, when sexually active bucks are used.

Ovulatory activity of female goats adapted to the subtropics is responsive to photoperiod.

The objective of this study was to determine whether reproductive seasonality of local well-fed female goats from subtropical Mexico (26 degrees N) can be controlled by photoperiod. The control group (n=12) remained in an open pen under natural photoperiod variations. The two experimental groups (n=8 each) were placed in light-proof rooms and exposed for 2 yr to alternations of 3 months of long days and 3 months of short days. One group was first exposed to long days, Group 1, and the other one to short days, Group 2. Blood samples were obtained twice a week to determine ovulation status by progesterone plasma concentrations. Goats from the control group displayed a seasonality of ovulations. The mean (+/-SEM) dates of the onset and end of the ovulations were September 10+/-5 d and February 16+/-4 d, respectively. In contrast, in both experimental groups, ovulations were modified (P<0.05) by the photoperiodic treatments such that ovulations started and ended during short and long days, respectively. In Groups 1 and 2, ovulations started 67+/-2 and 66+/-2 d (P>0.05), respectively, after the transfer from long to short days. In contrast, the timing of the cessation of ovulations after the transfer from short to long days differed (P<0.05) between groups (19+/-3 and 31+/-3 d for Groups 1 and 2, respectively). Local female goats from subtropical Mexico are, therefore, sensitive to photoperiodic changes that they are exposed to at this latitude and this environmental cue may control the timing of the breeding season in natural conditions.

Importance of the signals provided by the buck for the success of the male effect in goats.

Under temperate and subtropical latitudes, ewes and goats display a reproductive seasonal pattern and their sexual activity during the anestrous period can be stimulated and synchronized by the introduction of males in the group, which is called the "male effect". The response of females to the male effect in the middle of the anestrous season is weak or absent. This failure may be due to the inability of the female to respond to males, as a result of a refractoriness of the female to the male stimulus. But, it may also be due to a low quality stimulus provided by the male which is, as the females, in seasonal rest. We tested this latter hypothesis in seasonally inactive goats kept under subtropical conditions by comparing the use of males with their sexual behavior stimulated or not by photoperiodic treatments. Treated males were able to induce estrous activity of females during the whole anestrus season. We have also determined that previous separation of the males and continuous contact during teasing are not absolute requisites when active bucks are used. While odor from the male and its sexual behavior play a primary role in inducing ovulation, vocalizations appear to facilitate the display of the does' estrous. It remains to be determined to which extent these conclusions apply under temperate latitudes and with more seasonal breeds.

Evidence that the photoperiod controls the annual changes in testosterone secretion, testicular and body weight in subtropical male goats.

The aim of this study was to determine whether the reproductive seasonality of local male goats from subtropical Mexico (26 degrees N) is controlled by photoperiod. The control group (n = 7) remained in an open shed under natural daylight. The two experimental groups (n = 6 each) were placed in light-proof buildings and exposed for 2 years (yr) to alternations of 3 months (mo) of long days and 3 mo of short days. One group was first exposed to long days and the other one to short days. Body and testicular weights were determined every 2 wk. Blood samples were obtained weekly to determine testosterone plasma concentrations. In the control group, the body weight exhibited variations (P < 0.0001) and it increased during the non-breeding season. In both treated groups, long days stimulated weight gain and short days inhibited it (P < 0.0001). In the control group, testicular weight displayed variations (P < 0.0001), and high values were registered in June. In the treated groups, a testicular weight reduction occurred 6-9 mo after the onset of the study. Afterwards, the changes in testicular size varied according to daylength (P < 0.01). The pattern of plasma testosterone concentration in the control group varied over the study (P < 0.0001) and the levels were higher from May-June to November. In both treated groups, the changes in testosterone secretion occurred according to photoperiod changes (P < 0.0001). Short days enhanced testosterone secretion one photoperiodic cycle after the onset of the study and long days inhibited it. Local male goats from subtropical Mexico are sensitive to photoperiodic changes and this environmental cue may control the timing of the breeding season in natural conditions.

Management of photoperiod to control caprine reproduction in the subtropics.

Reproductive seasonality is observed in some breeds originating from or adapted to subtropical latitudes. In 'photoperiodic flexible breeds', such as Australian cashmere goats, the annual breeding season can be manipulated through nutrition, whereas in 'photoperiodic rigid breeds', such as Creole goats from subtropical Mexico, sexual activity can be controlled by altering the photoperiod. In males from the latter breed, artificial long days, whether or not accompanied by the administration of melatonin, stimulate sexual activity during the non-breeding season. These treated males are able to induce the sexual activity of anoestrous females through the male effect under intensive or extensive conditions. Photoperiodic treatments and the male effect can be easily integrated into different breeding management systems in subtropical latitudes.